Comprehensive reassessment and visioning. NCVHS began a process in 1999 to define a vision for health statistics in the 21st century, working jointly with NCHS and the HHS Data Council. Health statistics are an important aspect of the population health dimension. They characterize the health of a population and the influences on the health of a population — factors that include the environment, genetic and biological characteristics, health care, community resources, and political and cultural contexts. Health statistics are used to design, implement, monitor, and evaluate specific health programs and policies.

The health statistics visioning process has involved discussion groups that met throughout the United States, regional public hearings, expert meetings, forums at professional association meetings, and a National Academy of Sciences workshop. The overall objective was to elicit a broad range of expert opinion from public health and medical professionals on the major trends and issues in population health and their implications for future information needs. The visioning process will result in the publication of a final report in 2002. The report will include suggestions for program planning and criteria for evaluating future health statistics systems. The NCVHS Workgroups on the NHII and on 21st Century Health Statistics have coordinated their efforts. One of the anticipated benefits of these closely related endeavors is that the work products will clarify the interconnections between population health and individual health and those between health and health care, as well as the implications for health information policy.

Local, State, and Federal systems. With current legacy public health systems, information on population health is transmitted from localities to States to the Centers for Disease Control and Prevention (CDC) via stovepipe systems that have evolved separately as a result of categorical congressional funding. CDC has several initiatives to link these self-contained, unconnected systems.

The Health Alert Network (HAN) is a nationwide integrated information and communications system that serves as a platform for distributing health alerts and disseminating prevention guidelines and other information. 29 It also serves as a platform for CDC's bioterrorism initiative and other efforts to strengthen State and local preparedness. The HAN currently encompasses 39 States. When completed, it will ensure high-speed, secure Internet connections for local health officials; capacity for rapid and secure communications with first-responder agencies and other health officials; capacity to securely transmit surveillance, laboratory, and other sensitive data; and an early warning broadcast alert system. The project includes training for public health workers in the use of information technology.

The National Electronic Disease Surveillance System (NEDSS) is a broad initiative using data and information system standards for development of efficient, integrated, and interoperable surveillance systems at State and local levels. 30 NEDSS is built so that data from healthcare providers can be sent to the health department via a secure "pipeline" to protect sensitive data. The focus initially has been on tracking systems for infectious diseases, including emerging infections, and management of possible bioterrorism events. Fifty States have received funding to plan and, in 36 health jurisdictions (35 States and 1 metropolitan health department), to implement NEDSS compatible systems. A NEDSS compatible system for State use, the NEDSS Base System, is also being developed that will incorporate standard messages, a database model, and a platform for other modules. Twenty health jurisdictions have received funding to implement the NEDSS Base System in 2002.

Data definitions. CDC's related Public Health Conceptual Data Model provides the framework for categories of data for public health, especially surveillance. It already has been helpful in representing public health data needs to standards development organizations, specifically to promote the inclusion of the public health perspective in standards development. (This is also the objective of the Public Health Data Standards Consortium.) The model is being harmonized with the HL7 Reference Information Model. In addition to engaging in developmental work with States, standards development organizations, and other stakeholders, CDC has begun integration testing of the NEDSS Base System at the State level. 30

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